PROJECT SUMMARY/ABSTRACT Gestational diabetes (GDM) affects 5-10% of pregnancies in the US and strict control of maternal glucose is necessary to decrease the risk of serious maternal and fetal complications. This clinical research proposal stems from studies demonstrating that text messaging is an effective way to improve management of diabetes outside of pregnancy. I have developed and tested a novel text message library called Text For Success in Gestational Diabetes (Txt4GDM) specifically tailored for women with GDM that includes reminders for self-monitoring of blood glucose, positive feedback to user reported blood glucose values, educational, and motivational messages. The goal of the proposed F32 project is to perform a randomized clinical trial in women with newly diagnosed GDM to assess the impact of a text messaging program on adherence to self-monitoring of blood glucose and diabetes distress. The applicant will perform a randomized clinical trial in which women with GDM are either enrolled in the text messaging program or receive usual care for 6 weeks. The aims of the project are: 1) To test the hypothesis that the Txt4GDM text messaging program will increase adherence to self- monitoring of blood glucose compared to women receiving usual care. The hypothesis is that the messaging program will increase adherence (the number of blood glucose measurements checked compared to the total number of blood glucose measurements recommended) compared to usual care. 2) To test the hypothesis that the Txt4GDM text messaging program decreases diabetes distress (a specific form of emotional stress related to managing diabetes) compared to usual care. The hypothesis is that women enrolled in the messaging program will have lower diabetes distress as assessed by validated questionnaires compared to women receiving usual care. The results of the proposed research could greatly enhance understanding of the use of text messaging for improving adherence and decreasing distress in women with GDM, which could improve maternal and fetal outcomes. The training plan includes dedicated mentorship by Ellen W. Seely, MD (sponsor), Marie McDonnell, MD (specialty mentor in clinical care of GDM), and Alexander Turchin, MD (specialty mentor in quality and outcomes research), each offering expertise tailored to the applicant?s needs and goals. Additionally, the applicant will complete formal training in scientific communication, grant writing, and qualitative methods through the Harvard Catalyst Clinical/Translational Science Center and the Harvard T.H. Chan School of Public Health. These activities will provide the applicant with the necessary tools critical for development toward a career as an independent clinical researcher in the field of diabetes in pregnancy.